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MEENAKSHI EMERGENCY AND GENERAL

HOSPITAL

VITAL SIGNS AND INPUT OUTPUT CHART


Name of the patient: ………………………………………… Date: ……..………………………
Age/sex: ……………………………………………………….....
TIME TEMP BP SPO2 PR RR GRBS INPUT OUTPUT signature
12am
1am
2am
3am
4am
5am
6am
7am
8am
9am
10am
11am
12pm
1pm
2pm
3pm
4pm
5pm
6pm
7pm
8pm
9pm
10pm
11pm
12am
1am
2am
3am
4am
5am
6am
7am
8am
9am
10am
11am
12pm
1pm
2pm
3pm
4pm
5pm
MEENAKSHI EMERGENCY AND GENERAL
HOSPITAL

Name of the patient: ………………………………………… Date: ……..………………………


Age/sex: ………………………………………………………....

TIME MEDICATIONS/DIET NURSING NOTES

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